Provider Demographics
NPI:1144466715
Name:LYDIA DWUMA
Entity type:Organization
Organization Name:LYDIA DWUMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DWUMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, HP (ASCP)
Authorized Official - Phone:469-252-4832
Mailing Address - Street 1:10945 ESTATE LN
Mailing Address - Street 2:SUITE 135
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2317
Mailing Address - Country:US
Mailing Address - Phone:469-252-4832
Mailing Address - Fax:214-221-2997
Practice Address - Street 1:10945 ESTATE LN
Practice Address - Street 2:SUITE 135
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2317
Practice Address - Country:US
Practice Address - Phone:469-252-4832
Practice Address - Fax:214-221-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-01
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health